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General NPI Number Information
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NPI Number | 1215227913
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Entity Type | Organization
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Legal Business Name | CORALMED CENTER GROUP, INC.
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Dates
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Enumeration Date | 04/14/2011
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Last Update Date | 03/27/2022
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Provider Practice Location Address
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Address Line | 4178 W 12TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-4158
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Country | US
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Telephone | 305-921-9230
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Fax | 305-822-1895
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Provider Business Mailing Address
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Address Line | 5655 SW 192ND TER
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City | SOUTHWEST RANCHES
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State | FL
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Zip | 33332-3320
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Country | US
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Telephone | 786-376-1035
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MELISA ALVAREZ
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Credential |
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Telephone | 305-921-9230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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